Seybold D, Gekle C, Fehmer T, Pennekamp W, Muhr G, Kälicke T
Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum.
Chirurg. 2006 Sep;77(9):821-6. doi: 10.1007/s00104-006-1181-8.
The standard method of treating acute primary dislocation of the glenohumeral joint is immobilization of the arm in adduction and internal rotation with a sling. The recurrence rate for anterior instability after nonoperative treatment in young active patients is extremely high (up to 90%) and well reported. A new method of immobilization with the arm in external rotation improves the position of the displaced labrum on the glenoid rim. With the use of control MRI before and after immobilization in external rotation, a study on this new repositioning of the labrum is evaluated.
Ten patients (mean age 30.4 years) with primary anterior dislocation of the shoulder and Bankart lesion as shown on MRI but with no hyperlaxity of the contralateral side were immobilized in 10-20 degrees of external rotation for 3 weeks. Scans with MRI were taken in internal and external shoulder rotation post trauma and in internal rotation after 6 weeks. All patients were reevaluated after 6 and 12 months.
Dislocation and separation of the labrum were both significantly less with the arm in external rotation due to the tension of the anterior capsule and the tendon of the subscapularis muscle. In the MRI taken in internal rotation 6 weeks post trauma, all Bankart lesions were fixed in reposition after three weeks of immobilization in external rotation. At 12-month follow-up, the average Constant Score was 96.1 points (range 63-100), and the Rowe Score was 91.5 points (range 25-100). One patient had traumatic redislocation after 8 months.
After primary shoulder dislocation, immobilizing the arm in 10-20 degrees external rotation provided stable fixation of the Bankart lesion in an anatomic position. First long-term indications from an ongoing prospective study of recurrence rates after immobilization in external rotation are promising.
治疗急性原发性盂肱关节脱位的标准方法是用吊带将手臂固定在内收和内旋位。在年轻活跃患者中，非手术治疗后前向不稳定的复发率极高（高达90%），且已有充分报道。一种将手臂固定在外旋位的新方法可改善移位的盂唇在肩胛盂边缘的位置。通过在外旋固定前后使用对照MRI，对这种盂唇的新复位方法进行了评估。
10例患者（平均年龄30.4岁），MRI显示为原发性肩关节前脱位和Bankart损伤，对侧无关节过度松弛，将其手臂固定在外旋10 - 20度位3周。在创伤后肩关节内旋和外旋时以及6周后内旋时进行MRI扫描。所有患者在6个月和12个月后进行重新评估。
由于前关节囊和肩胛下肌腱的张力，手臂在外旋位时盂唇的脱位和分离均明显减少。在创伤后6周内旋位的MRI检查中，所有Bankart损伤在手臂外旋固定3周后均复位固定。在12个月的随访中，Constant评分平均为96.1分（范围63 - 100），Rowe评分为91.5分（范围25 - 100）。1例患者在8个月后出现创伤性再脱位。
原发性肩关节脱位后，将手臂固定在外旋10 - 20度可使Bankart损伤在解剖位置上得到稳定固定。正在进行的关于外旋固定后复发率的前瞻性研究的首批长期指标很有前景。
